Hormone Replacement Therapy: first line treatment for menopausal women under age 60

If you’ve seen the news recently, you may have heard about a new publication from the Canadian Medical Association stating that more women suffering from symptoms of menopause should be presented with the option of hormone therapy.

The paper published mentions that hormone replacement therapy (HRT) should be considered as the initial treatment option for menopausal women under the age of 60 due to compelling evidence supporting the benefits of HRT in managing menopausal symptoms and preventing associated health risks.

Perimenopause and menopause often bring various uncomfortable symptoms such as hot flashes, mood swings, poor sleep, cognitive changes, joint pain, and vaginal dryness. In addition to these symptoms,menopause is linked to an increased risk of osteoporosis, cardiovascular disease, and cognitive decline.

Traditionally, HRT has been prescribed to alleviate menopausal symptoms, but its use has been debated due to concerns about overstated risks coming out of the Women’s Health Initiative study (more on this another time).  It’s important to mention that there have always been guidelines suggesting HRT for menopausal women, nothing here has changed, but it hasn’t been happening on a practitioner level. I find this is often out of a lack of time for inquiry and screening on the practitioner level, a lack training in this area and women not bringing their symptoms forward to their practitioner because it’s seen as a normal life transition. This paper summarizes the benefits of HRT and urges clinicians to inquire about symptoms during the menopause transition and discuss treatment options with their patients.

This publication emphasizes that HRT, when initiated early during menopause, offers significant benefits with minimal risks. HRT effectively reduces the frequency and severity of hot flashes, improves sleep quality, and alleviates mood swings in menopausal women. Furthermore, it reduces the risk of osteoporosis by preserving bone density and decreasing the incidence of fractures. HRT is also shown to have a positive impact on cardiovascular health, reducing the risk of heart disease and stroke.

Of course, like any medical decision, individual screening is important and cannot be overlooked. HRT isn’t for everyone and does carry a significant amount of harm for a small subset of the population, like most treatments.

This is an exciting time! Perimenopause and menopause, which can start as early as late 30’s carries an array of debilitating symptoms as well as chronic health risks. HRT is a fantastic tool that can be useful for some women if initiated at the correct time.

In my practice, I work with a lot of women in this stage of life,and I’ve found there is a severe lack of awareness of the support that is possible. If you have asked your doctor about HRT or complained about perimenopause or menopausal symptoms and you have been told that it’s “a part of life” and that it “will pass” and you are not offered support, know that this is not the correct standard of care. You may not be a candidate for HRT, due to increased risk, but you should at the very least be screened and educated on why it is not the best solution for you. Outside of HRT, there are also several options to support you during this time.

The conversation around HRT is fantastic, but I am mostly excited because we are finally talking about how to support this population; rather than belittling symptoms and invalidating the wave of changes to their health they are experiencing.

Did you know that Naturopathic Doctors in Ontario who have obtained a prescribing licence, are able to prescribe HRT? There are options out there for you, make sure you are working with a practitioner who knows what they are doing in this area.

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